Tag: Obamacare

On the eve of the second enrollment period for Obamacare — which begins November 15 — insurers in the state are not getting what they asked for. During the first six-month enrollment period, which ended officially March 31 of this year but was extended due to website glitches, 370,000 state residents were able to sign up for private health insurance through the Affordable Care Act.

People can sign up for Medicaid at any time during the year. Though not restricted to the enrollment periods, some 600,000 people signed up during the last one, including many who were previously uninsured. This makes nearly a million New Yorkers affected by Obamacare.

The ACA was instituted to control the health insurance industry. There were 44 million uninsured Americans, the highest in history, and the law was designed to require that everyone be insured, with fines to motivate those who didn’t sign up. People who don’t have coverage by 2015 will pay a penalty of $325 per adult, $162.50 per child or two percent of income, whichever is higher. Other factors in the plan include expansion of the Medicaid program and elimination of restrictions on pre-existing conditions.

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Seventeen health insurance companies have stepped up and offered New Yorkers four levels of plans (plus an ominous-sounding “catastrophic” category) with standardized contract terms and product offerings. Consumers can now comparison-shop among them. Enrollments for New York’s health exchange marketplace, one of the most important early stages of the federal Affordable Care Act (Obamacare), will begin October 1, and coverage will become effective on the first day of 2014.

How much will eligible persons in the Hudson Valley pay for health insurance? According to the healthbenefitsexchange.com website, premiums for individual New Yorkers for the most comprehensive plan, “platinum,” will range depending on the vendor chosen from $446.25 to $994.34 monthly. Premiums for the plan with the lowest of the four levels of benefits, “bronze,” will be offered from $265.89 to $589.91 per month. Multiply those premiums by 1.70 for the inclusion of children, 2.00 for spouses and 2.85 for families. The rates approved are subject to final certification of the insurers’ participation in the exchange.

The new premium rates do not affect a majority of New Yorkers, who receive insurance through their employers, only those who must purchase it on their own, an article in the July 16 New York Times explained. Because the cost of individual coverage has soared, only 17,000 New Yorkers currently buy insurance on their own. About 2.6 million are uninsured in New York State. State officials estimate that as many as 615,000 individuals will buy health insurance on their own in the first few years the health law is in effect. In addition to lower premiums, about three-quarters of those people will be eligible for the subsidies available to lower-income individuals.

The marketplace has been a long time coming. Governor Andrew Cuomo attributed the expectation that the expensive private insurance rates for individuals will decrease at least half to the influence of the newly constructed competitive marketplace. “New York’s health benefits exchange will offer the type of real competition that helps drive down health-insurance costs for consumers and businesses,” said Cuomo.

Crain’s New York Business provided perhaps the most animated reaction. “When the Cuomo administration gave word last week that individual health-insurance premiums offered through the state exchange to launch in October would be at least 50 percent cheaper than what some New Yorkers pay now, it was like tossing food pellets into a pond of starving fish,” said a Crain’s editorial last Friday. “Groups supporting the Affordable Care Act celebrated the news in TV ads, seeking to beat back Republican efforts to repeal Obamacare. Critics of the law fought back, arguing that the numbers were deceiving or downright false.”

New York has required insurers to cover everyone regardless of pre-existing conditions, but did not require everyone to purchase insurance — a feature of the new health-care law — and did not offer subsidies so people could afford coverage. With no ability to persuade the young and the healthy to buy policies, the state’s premiums to individuals have long been among the highest in the nation.

New Paltz Chamber of Commerce President Michael A. Smith. (photo by Lauren Thomas)

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The movement toward implementation of the federal Affordable Care Act will continue in 2013 as one of the very biggest issues in American society. It’s going to be as big an issue in 2014, and in 2015 as well. And every year beyond that for perhaps a decade. So we might as well be prepared to deal with it.

Health insurers and most provider organizations are better prepared than they were a couple of years ago. The provisions of the federal legislation require them to come to terms with the subsidized healthcare benefit exchanges scheduled to go into business in every state of the nation less than a year from now.

Other deadlines are looming, too. The players are scrambling to participate in a variety of experiments, figuring out how most effectively to find their niche in cooperation with other healthcare organizations. Most if not all are also wrestling with the implementation of electronic health records and other tools of information technology.

By October 31 of this year, health insurers will be competing for New York customers in the state-run health benefit exchange. This is no small enterprise. New York, one of the most aggressive states in setting up its state-run health benefit exchange, is getting tens of millions of dollars in the form of federal grants to fund implementation.

According to the 2009 American Community Survey, some 121,000 of the medically uninsured in the seven counties of the mid-Hudson region (Westchester, Putnam, Rockland, Dutchess, Orange, Sullivan and Ulster counties) will gain coverage as a result of the ACA. With the state health benefit exchange in place, the uninsured in the region will decrease from 15 per cent to nine per cent of the population.